Contact

Payer

Pharma

Provider

Formulary guidance and transparency from P&T to point of care

Radar On Market Access: Managed Care Strategies for Specialty Pharmaceuticals

Posted by Matt Breese on May 22, 2018

A survey by EMD Serono, Inc. revealed that managing oncology drugs and services remains the top challenge for health plans, tied with determining the value of specialty drugs and ensuring clinically appropriate use of specialty therapies.
 
Released at the end of April, the 14th edition of the EMD Serono Specialty Digest: Managed Care Strategies for Specialty Pharmaceuticals is based on survey responses from 59 commercial health plans representing more than 76 million covered lives. 
 
Read More

Topics: Industry Trends, Market Access, Data & Analytics

Radar On Market Access: American Patients First Blueprint

Posted by Matt Breese on May 17, 2018

After more than a year of promising action to counter the high costs of prescription drugs, the Trump administration on May 11 unveiled its American Patients First blueprint aimed at lowering medication prices and reducing costs for consumers, AIS Health reported.
 
Steve Wojcik, vice president, public policy, National Business Group on Health, says the blueprint "generally followed what was in the Administration’s proposal budget, by and large."
 
Read More

Topics: Industry Trends, Provider

Radar On Market Access: Outcomes-Based Drug Pricing

Posted by Matt Breese on May 15, 2018

While outcomes-based contracts for prescription drugs are a continual hot topic in the health care industry, experts who spoke on a panel May 1 at the World Health Care Congress cited several barriers that are keeping these contracts from proliferating widely: chiefly, not enough reliable data and regulatory issues such as the federal antikickback statute.
 
"The beautiful thing about value-based contracts is we are basically putting the patient at the center of everything," said Enrique A. Conterno, senior vice president of Eli Lilly and Co.
 
Read More

Topics: Industry Trends, Market Access, Payer

Radar On Market Access: CMS Targets Opioid Utilization

Posted by Matt Breese on May 10, 2018

CMS on April 2 finalized new policies in its 2019 Rate Announcement and Final Call Letter for Medicare Advantage (MA) and Part D plans that continue to focus heavily on ways to monitor and decrease opioid misuse, AIS Health reported.
 
To reduce the potential for chronic opioid use or misuse, CMS said that it expects Part D plan sponsors to implement a hard safety edit to limit initial opioid prescription fills for treating acute pain to no more than a seven-day supply. It also requires plan sponsors to implement an opioid care coordination edit at 90 morphine milligram equivalents per day.
 
Read More

Topics: Industry Trends, Market Access, Payer

Radar On Market Access: Pharma's Role in Prior-Authorization Conflict

Posted by Matt Breese on May 8, 2018

Through funding of patient support programs and related hub services, pharma companies are playing a role in lessening the prior-authorization conflict between insurers and providers, AIS Health reported. .
 
Prior authorization (PA) is the exchange of patient health and medication information between a provider and a plan to make a coverage determination. Yet the most recent survey by the American Medical Association (AMA) showed that 92% of respondents agree that PAs delay therapy access, while 84% considering it a “high” burden. 
 
Read More

Topics: Industry Trends, Data & Analytics

Radar On Market Access: CVS’s Chronic Kidney Disease Program

Posted by Matt Breese on May 3, 2018

CVS Health Corp. recently unveiled an initiative aimed at improving the management of chronic kidney disease (CKD), a costly condition that affects millions in the United States, AIS Health reported.
 
The multipronged program incorporates, among other things, a focus on early disease identification and patient education. According to estimates from the Centers for Disease Control and Prevention, 30 million people in the U.S. have CKD. But many of them don’t realize it. 
 
Read More

Topics: Industry Trends, Data & Analytics, Payer

Radar On Market Access: Statin Gender Bias

Posted by Matt Breese on May 1, 2018

Women remain less likely than men to receive guideline-recommended, high-intensity statin therapy within 30 days after hospitalization for myocardial infarction (MI), AIS Health reported based on recent research published in the April 24 Journal of the American College of Cardiology.
 
The research looked at nearly 17,000 adults in the U.S. younger than 65 with commercial insurance and about 71,000 seniors ages 66-plus with Medicare coverage who were hospitalized for MI between 2014 and 2015. They found that 47% of women vs. 56% of men filled a high-intensity statin prescription within the 30-day post-hospitalization period. 
 
Read More

Topics: Industry Trends, Market Access, Data & Analytics, Payer

Radar on Market Access: Specialty Drug Spend

Posted by Matt Breese on Apr 26, 2018

The United States saw a 0.6% increase in net spending on medications to $324 billion last year, AIS Health reported based on IQVIA Institute for Human Data Science’s report.

Those numbers represent "the amount being received by pharmaceutical manufacturers net of rebates, off-invoice discounts and other concessions," said Murray Aitken, executive director of the institute. But on an invoice basis, total spending was $453 billion, according to Medicine Use and Spending in the U.S.: A Review of 2017 and Outlook to 2022.

Read More

Topics: Specialty, Industry Trends, Data & Analytics

Radar On Market Access: Psoriasis Therapies

Posted by Matt Breese on Apr 24, 2018

With various psoriasis therapies available, payers should make certain they have a complete picture of the autoimmune condition and the various factors that could impact their members’ treatment, AIS Health reported.
 
According to the American Academy of Dermatology, psoriasis affects about 7.5 million people in the United States, with about 150,000 new cases each year. As the condition can impact relationships, it could lead to depression and stress. Other common conditions may occur in patients with psoriasis as well, including psoriatic arthritis, uveitis, metabolic syndrome and diabetes.
 
Read More

Topics: Industry Trends, Market Access, Payer

Radar On Market Access: New Financing Strategies for Innovative Therapies

Posted by Matt Breese on Apr 17, 2018

While breakthrough clinical treatments have the potential to change patients’ lives, their high upfront costs raise tricky questions for payers. A recent webinar hosted by the National Pharmaceutical Council explored some potential solutions to these financing challenges, AIS Health reported.
 
Finding a realistic and workable financing mechanism is important for patients, as the price tag for some new therapies is indeed steep. 
 
Read More

Topics: Specialty, Industry Trends, Market Access, Payer